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Mental health: How three people are falling through the cracks

The Star goes inside Canada&rsquo;s mental health system to show how and where patients are failed in diagnosis, treatment and continuity of care

Réal Leclair, 52, who lives in a lean-to under railway tracks in Toronto and fights permanent delusions he is being raped and beaten. He's one of three people with a serious mental-health illness the Star follows this week.
(Pawel Dwulit / Toronto Star) | Order this photo

By Chantaie Allick, Liam Casey and Jennifer PagliaroStaff Reporters

Mon., May 28, 2012

They may be surrounded by people, but they are alone, held hostage by their minds. They are with you on the bus, in the next cubicle and at the playground. They are teachers, lawyers and police officers, young and old, men and women. They live with pain. Some kill themselves as a final cure.

In Canada, 1 in 5 people live with mental illness and chances are they aren’t receiving the help they need. The brain is a black hole whose inner workings remain a mystery whether the mind is healthy or not. Not only is diagnosis complex, but experts tell us that people with mental illness, unlike any other illness, don’t seek help.

Over the next three days, the Star goes inside Canada’s mental health system to show how it fails people at the diagnosis, compliance and aftercare stages. We’ll follow three people whose experience with serious mental-health issues represent countless others who have fallen through the cracks:

• Chan Bak, 27, who finally faces a diagnosis of schizophrenia after experiencing multiple psychotic breaks in the past three years;

• Lesley and David Skelly, who watched as their bright son Kit, 23, lost touch with reality as he repeatedly stopped the medication they know will halt his psychotic breaks, but will never bring back the boy they lost;

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• Réal Leclair, 52, who lives in a lean-to under railway tracks in Toronto and fights permanent delusions he is being raped and beaten.

This dovetails with the release of Changing Directions, Changing Lives, a long-awaited mental health strategy by the Mental Health Commission of Canada published May 8. It is the first joint effort by government, health-care providers and people with mental illness to fix an area of the health-care system that has been historically neglected.

The report makes recommendations in prevention, recovery, access, diversity, First Nations and leadership. It calls on governments to increase spending earmarked for mental health by $4 billion per year — from 7 per cent to 9 per cent of all health care spending.

The federal government endorsed the strategy the following day, but has made no financial commitment.

Treating illnesses of the mind poses challenges that are different from diseases of the body. There’s no blood test for depression or biopsy to diagnose schizophrenia. “Mental illness, unlike other illnesses, often drives people away from care,” says Dr. Thomas Ungar, head of psychiatry at North York General Hospital. “The illness and the way the system’s structured makes continuity of care a challenge.”

There has, however, been significant progress in the past six years, says Michael Kirby, the former senator whose 2006 report “Out of the Shadows at Last” led to the creation of the mental health commission. Kirby served as its chairperson, and now leads the new advocacy group Partners for Mental Health.

Kirby travelled Canada in 2005 to meet with provincial governments and local leaders. “Mental health was on nobody’s list” of priorities, he says.

The mental health system is not a system, Kirby says. “It’s a series of individual services loosely — very loosely — co-ordinated but hardly descriptive of a system.”

That hasn’t changed, he says, but now, “You would find every single one of them would put mental health in their top three (priorities).”

Kirby estimates it will be 10 or 15 years before the strategy laid out in Changing Directionsis in placeand Canada has a system that provides consistent care from diagnosis to recovery. We’re not there yet, he says, but “we have clearly turned the corner.”

The strategy has won praise for recognizing serious gaps in preventing stigma, recognizing the role of families and lack of community supports and incorporated perspectives froma broad range of stakeholders, from First Nations leaders, health-care professionals and people with mental illness themselves.

Mental-health problems cost Canada at least $50 billion per year, the report estimates, which amounts to 2.8 per cent of the country’s gross domestic product.

“I don’t think the mental-health file in general is a high enough priority for government,” says Steve Lurie, executive director of the Canadian Mental Health Association’s Toronto branch. “The (Ontario) government invested $16.5 billion in health care over the last eight years but only $220 million in mental health.”

In 2011, Ontario made an additional commitment to spend $257 million over three years to mental health projects for young people.

But focusing on dollars alone is the wrong approach, Kirby says. “It always seems to come down to how much money are you going to put into the system,” he says.

Governments and agencies should also examine how they’re spent. And it’s up to them to decide how to bring the strategy’s recommendations to life.

Investing in programs that help people access treatment early or stay out of hospitals is cost-effective, evidence shows.

More than 6.7 million people in Canada live with a mental health problem or illness today. That’s almost 20 per cent of the population.

This series looks at the 3 per cent with severe mental illness, including schizophrenia, major depression, bipolar disorder, anxiety disorder and personality disorders.

Workplaces, governments, media, hospitals, courts and researchers are also involved in creating and developing the services and policies that treat people with mental illnesses.

But it’s still the stories of each person living with mental illness who matter most.

They are your loved ones, your coworkers, your friends, your neighbours.They are part of the system, yet they have fallen through.

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